Der Orthopäde
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Isolated deviations in flexion and extension of the leg axis are rare. These deviations can be corrected if necessary by osteotomy and the range of motion (ROM) of the knee joint can be optimized. In addition to correction in the frontal plane, the tibial slope (i.e. inclination of the surface of the tibial joint) can also be influenced by osteotomy and therefore osteotomy can also be utilized to optimize the biomechanical stability of the knee joint. ⋯ Careful planning taking all three spatial planes and torsion into consideration is the foundation of a successful operation. A controlled surgical technique based on careful planning and some basic principles allows the alteration of the three dimensional alignment of the tibia.
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Inveterated fractures or dislocations of the foot which are defined as being more than 6-12 weeks old can be secondarily reconstructed anatomically in only very rare cases. All other cases need reorientation of all axes of the foot requiring single or combined joint fusion. ⋯ Old cases of dislocation, for example after subtalar dislocation without anatomical reduction, need reorientation of the foot axes by performing arthrodesis. Subluxation of the medial Lisfranc joint after an unrecognized rupture of Lisfranc ligament can be controlled later by anatomical repair of this ligament by using half of the extensor digitorum longus tendon and thus avoiding arthrodesis.